The terms in plain language
The menopause is a woman's last menstrual period, and it is confirmed in retrospect, once twelve consecutive months have passed without a period. It usually happens around the age of 50. The climacteric is the wider transition around it, which can begin several years earlier and continue afterwards. It is not an illness but a normal stage of life.
What changes
As the ovaries gradually produce less estrogen, symptoms appear that vary greatly in intensity from woman to woman:
- An irregular cycle, with changes in how often periods come and how heavy they are.
- Hot flushes and night sweats.
- Disturbed sleep.
- Vaginal dryness and discomfort during intercourse.
- Mood changes, irritability and difficulty concentrating.
- Urinary urgency or recurrent urinary infections.
- Joint pains and changes in body composition.
What to watch for in the longer term
The fall in estrogen accelerates bone loss and increases cardiovascular risk. This is therefore the right time for a bone density scan where indicated, for blood pressure and lipid measurements, and for a conversation about diet, resistance exercise, calcium and vitamin D.
How it is treated
Treatment is fully individualized. Many women need no treatment at all. When symptoms affect quality of life, the options include local vaginal preparations for genitourinary symptoms, non-hormonal treatments, and hormone replacement therapy.
Hormone therapy is the most effective option for hot flushes, but whether it is suitable depends on your age, how long it is since the menopause, and your personal and family history — particularly with regard to breast cancer and thromboembolic disease. Your doctor will weigh the benefit and the risk with you and will review the decision regularly.
When to see your doctor
Tell the clinic straight away if you have any bleeding after the menopause — that is, once a year has passed without a period. It always needs to be investigated. The same applies to very heavy or prolonged bleeding during the climacteric, and to symptoms that seriously affect your sleep or your daily life.